Oxymorphone
OPANA
Pronunciation: OX-i-mor-foen
“Ox sees more phones”
pinpoint pupils → opioid
What it isPotent full mu-opioid agonist; severe pain.
Why this oneMinimal CYP metabolism avoids CYP2D6 phenotype variability seen with several other opioids.
What limits itRespiratory depression, dependence, and benzodiazepine co-use drive overdose risk; alcohol can disrupt some extended-release formulations.
Pearls
- Opana ER withdrawn for abuse; generic ER remains.
- MME conversion factor 3.
- Take on an empty stomach; food raises peak levels.
Oxymorphone prescription history
Animated chart of estimated U.S. prescriptions per year, Opioid analgesics (1900–2026). Oxymorphone enters in 1959 (estimated).
FDA-approved for
- pain (2006)
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory depression, dependence and overdose; risk rises sharply with sedatives or impaired clearance.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute pain (opioid-naive) | Adults | 10-20 mg q4-6h PRN | lowest dose for adequate analgesia |
Renal Moderate-severe renal impairment: start at lowest dose (increased bioavailability)
Hepatic Contraindicated in moderate-severe hepatic impairment; mild: start at lowest dose
Instructions
- Take on empty stomach, at least 1 h before or 2 h after eating
- Taper gradually to discontinue in physically dependent patients
Available strengths
- tab 5, 10 mg
- ER tab 5, 7.5, 10, 15, 20, 30, 40 mg
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma in unmonitored setting or absence of resuscitative equipment
- Known or suspected GI obstruction, including paralytic ileus
- Moderate or severe hepatic impairment
Cautions
- Addiction, abuse, and misuse
- Life-threatening respiratory depression
- Neonatal opioid withdrawal syndrome
- Additive effects with benzodiazepines/CNS depressants
- Adrenal insufficiency
- Severe hypotension
Adverse reactions
- Nausea
- Pyrexia
- Somnolence
- Vomiting
- Pruritus
- Headache
- Dizziness
- Constipation
- Confusion
Pregnancy Prolonged use during pregnancy may cause neonatal opioid withdrawal syndrome
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 5 mg | tab | per unit | not offered | |
| 10 mg | tab | per unit | $1.22/ea | not offered |
Generic entry2010
Serotonicity
This drug is routinely called serotonergic. By Gillman’s human-effect criteria it does not raise serotonin in the synapse.
Opioid effects and respiratory/CNS-depressant interactions remain important, but this drug is not a clinically significant SRI by the Gillman framework.
Gillman’s four human testsA measurable SERT affinity that fails all four is not clinical serotonicity.
- Retarded orgasm
- Efficacy in OCD and cataplexy
- Clonus and hyperreflexia in single-drug overdose
- Serotonin toxicity when combined with an MAOI
Non-elevating actionNone recorded
Evidence confidenceHigh
Background: what serotonicity is · what is and is not an SRI · what counts as a relevant MAOI.
Open Oxymorphone in the interactive console ↗
Memory aids: interaction avatars
Open Oxymorphone in the interactive console ↗
Self-check
- Oxymorphone: Why is CYP2D6 phenotype variability less important?
Minimal CYP metabolism. - Oxymorphone: What can alcohol disrupt?
Some extended-release formulations.